Results

The majority of patients harboured pituitary adenomas (n=121; 69%), which were mostly treated transsphenoidally (93%). Sellar meningiomas comprised the second largest patient group (n=26) and were treated almost exclusively via a transcranial approach (96%). Other entities, like chordomas, pituitary metastasis, cysts, etc., were either approached transsphenoidally or transcranially. Mean duration of surgery amounted to 96Â±33 min for transsphenoidal procedures and to 237Â±106 min for transcranial procedures. There was no perioperative mortality. Transsphenoidal procedures were complicated by CSF fistula (2%) and postoperative hemorrhage in elderly patients in particular with incomplete tumour resection (3%). Temporary cranial nerve palsy and temporary diabetes insipidus were seen with both approaches (3% each). Deterioration of vision occurred in 16% after transcranial surgery, and affected mostly meningioma patients (6 of 26 patients; 23%). Interestingly, in 3 of these patients, visual impairment developed with some delay indicating (micro-)vascular dysfunction. Transcranial surgery was also complicated by rare adverse events like hemiparesis (n=1), cerebral vasospasm (n=1) and temporary memory disturbance (n=1). Overall rate of temporary and permanent morbidity was 11% and 1% for transsphenoidal procedures and 32% and 16% for transcranial procedures, respectively.

Conclusions

Transsphenoidal surgery of sellar lesions demonstrates very low rates of permanent morbidity. Transcranial surgery, however, can be associated with significant morbidity and rare complications. Especially visual impairment after removal of suprasellar meningiomas remains a major concern and may be attributed to microvascular compromise.